Provider Demographics
NPI:1801535596
Name:BANKS, ELIZABETH ASHLEY
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ASHLEY
Last Name:BANKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1924 LANDSTOWN CENTRE WAY
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-1624
Mailing Address - Country:US
Mailing Address - Phone:757-668-4673
Mailing Address - Fax:
Practice Address - Street 1:1924 LANDSTOWN CENTRE WAY
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-1624
Practice Address - Country:US
Practice Address - Phone:757-668-4373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-01
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07155103T00000X
VA0810008363103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist